Contemporary use of coronary computed tomography angiography in the planning of percutaneous coronary intervention

Planning of percutaneous coronary interventions (PCI) is largely based on anatomical information obtained with invasive coronary angiography. Over the last decade, intracoronary information obtained from both imaging and physiological techniques has gradually gained recognition for this purpose. Yet, coronary computed tomography angiography (CCTA) is still ignored by most interventionalists as a tool in the planning of PCI strategies. This has occurred despite major developments in CCTA, including physiological assessment, plaque characterisation, etc. Furthermore, it is foreseeable that many more patients referred to the catheterisation laboratory will have had a prior CCTA study. In this review we discuss the distinct advantages provided by CCTA in studying coronary artery structure and function. We revisit the most frequent scenarios of complex PCI and establish analogies between the use of intracoronary diagnostics and CCTA in setting procedural strategy, and in anticipating specific challenges.